In orthopedic surgical procedures, it is a practice to employ a special operating table to support the body and extremities of a patient in a desired position. Such operating tables generally include adjustable head, center and foot sections, and movable extension bars or members which have attachments to support and retain the arms and the legs of a patient in desired positions during a particular operatory procedure.
In operatory procedures on the hips and legs of a patient, as in the replacement, repair or pinning of fractures of the hip, or the pinning or casting of realigned bone fractures of the leg, it is a standard practice to place the leg under traction to extend the muscles, and realign and hold the bones in proper position during repair. Typically, this is done by fixing the position of the torso of the patient on the operating table and then applying a traction force to the leg along its longitudinal axis to extend the same. In the past, this has been accomplished by using a fixed vertical post on the operating table located in the crotch between the legs of the patient to hold the lower torso against downward movement, and a foot-retaining member attached to a traction crank of the operating table. The traction crank is mounted on an extension bar of the table and is manually operated to apply a pulling force to the patient's foot to extend the leg from the lower torso and maintain traction thereon for proper bone alignment during the surgical procedure.
In the past, various devices have been employed to position and secure the foot to the traction crank for application of a pulling force to the leg. One such holding device comprises a rigid metal heel cup and foot sole supporting plate attached to the traction crank to receive the patient's foot. The foot of the leg is then secured to the heel cup and sole support plate by a suitable fastening means.
One such fastening means comprises a muslin cloth bandage which is wrapped about the foot and ankle, and tied to the heel cup and sole plate.
Another device for securing the foot and leg to heel cup and foot support plate comprises a flexible reinforced cloth anklet which is strapped about the lower portion of the leg and anklet and is secured to the cup and foot by additional straps.
A more recent development has been the use of a modified form of shoe attached directly by the sole of the shoe to the traction crank. The shoe has an upper portion which receives and is laced about the foot and ankle of the patient.
The use of such foot-retaining traction devices has certain disadvantages and drawbacks. When a cloth muslin bandage is used to tie the foot of a patient to a rigid heel cup and support plate, the bandage can loosen and allow the foot to move in the bandage, resulting in misalignment of the leg. The pressure of the bandage around the arch of the foot also restricts blood circulation to the foot and toes, occasionally requiring interruption of the operatory procedure to loosen the bandage to prevent damage of the foot due to restricted blood flow. In addition, considerable time is required to wrap and tie the muslin bandage around the foot and the heel cup and foot plate in proper position for application of traction to the leg.
With respect to the use of a cloth anklet to secure the foot to the heel cup and foot plate, generally one size is insufficient to fit all size patients, requiring that the anklet be available in multiple sizes for use. Improper securement of the anklet on the foot can cause the foot to slip and become misplaced in the anklet, resulting in misalignment of the leg and improper placement of the same under traction. In addition, time is required to properly secure the anklet around the lower leg and the rigid heel cup and foot plate for application of traction to the leg.
With respect to the modified form of shoe attachment, care must be taken in properly positioning the foot in the shoe and in securing the shoe upper about the foot. On occasion, the foot may bend in the shoe resulting in misalignment of the foot and consequent improper positioning of the leg under traction forces. In addition, pressure of the shoe upper across the top of the foot restricts blood circulation and requires careful monitoring of the patient's foot to avoid possible damage by lack of blood flow thereto.